According to the World Health Organisation:
Screening for HIV in people who present with suspected malarial fever could identify large numbers of very recent HIV infections in countries with a high HIV burden
Screening for HIV in people who present with suspected malarial fever could identify large numbers of very recent HIV infections in countries with a high HIV burden, and could represent an effective way of integrating HIV and malaria control activities at the primary care level, especially if better point-of- care tests for diagnosing acute HIV infection can be developed, researchers report.
Between December 2006 to January 2007, one to three percent of all adults presenting at seven government rural health clinics in Uganda with suspected malaria were identified as having acute or early HIV infection, reported Lisa M. Bebell and colleagues in a cross-sectional study published in the advance online June edition of AIDS.
Settings that offer routine primary care and focus on the diagnosis and treatment of malaria in sub-Saharan African provide a unique opportunity to identify large numbers of people with acute HIV infection by offering point-of-care HIV testing and counselling, note the authors.
Acute HIV infection means high levels of the virus are circulating in blood and genital secretions. Transmission risks are higher during this time. Individuals in the acute phase of HIV infection, which lasts one to three months, are highly infectious and probably account for 30% or more of new infections, note the authors. Identification of individuals at this stage is challenging and thus infrequent. People may not seek care, and even when they do HIV may not be considered.
The symptoms of acute HIV infection can mimic those of malaria. Over 300 million cases of malaria are diagnosed each year in sub-Saharan Africa where the burden of HIV is the greatest. Flu-like symptoms consistent with malaria are the most common reason for health clinic visits in sub-Saharan Africa accounting for 30 to 50% of all outpatient visits.
So identification of those with acute HIV infection presents a critical missed opportunity to help prevent HIV transmission, note the authors.
The authors used a cross-sectional design to see what the prevalence of acute, early and established HIV infection was among patients suspected of having malaria.
Following accepted methodology, adapted for use on dried blood, the authors identified acute, early and established HIV infection.
Acute HIV infection was defined as a period of approximately three weeks in which patients show detectable HIV-1 RNA but have negative or indeterminate results on antibody immunoassay and Western blot tests.
Early HIV infection was defined as HIV-1 RNA positive with a positive Western blot pattern but a poor antibody response.Seven thousand patients of all ages referred by health care providers for malaria blood smears (but not for consideration of HIV infection) were prospectively (and consecutively) recruited at seven rural government health clinics representative of the diversity of malaria and HIV prevalence across Uganda. Services were provided free of charge.
Of the 7000, those aged 13 and over (2893 or 41%) were included in the study.
Of these, 17% (494) had blood smears positive for malaria, varying from 3.4 to 30% by site; 324 (11.2%) were HIV-infected, with site prevalence ranging from 1.4 to 16.9%.
In total, 26.5% of all HIV-positive adults were identified as having acute (30 or 9.3%) or early (56 or 17.3%) HIV infection. Of the total population, patients with acute, early and established infection represented 1.0%, 1.8% and 8% respectively.
Site prevalence for acute and early HIV infection varied ranging from 0.5 to 6% of all adult patients.
Site-level predictors for acute HIV infection, among all patients, included high HIV prevalence (greater than 10 percent) (OR 4.5, P=0.006) and low levels of endemic malaria (OR 2.8, P=0.015).
Four to six per cent of all adults suspected of having malaria and who met the criteria for acute HIV infection were from the three study sites with the highest HIV prevalence, ranging from 10.6 to 16.9%.
The authors believe by evaluating patients who present with flu-like symptoms at general health clinics across sub-Saharan Africa, large numbers with acute or early infection can be identified.
The authors cite a study that showed patients with acute HIV infection reduced their HIV transmission risk behaviour by 98% in the eight weeks following diagnosis compared to the eight weeks before diagnosis. This would further provide an impetus for finding HIV sero-discordant couples, that is before transmission has occurred to the negative partner.
Limitations, according to the authors, include cross-sectional analysis that could have led to misclassification. In additional, methods used involving dried blood spots and pooling estimates may have underestimated those with acute infection. Improved methods are needed to identify the true proportion of those with early HIV infection, note the authors.
The authors highlighted the fact that the resource-intensive nature of the testing used in this study is not practical in most resource-poor settings. The unique method of using RNA in pooled dried blood spots is easily used in such a setting, while the nucleic acid amplification testing used requires a central laboratory and specialised equipment. This is not practical for real-time detection of infection, they note, but it could be used in further research to confirm clinical cases where refrigeration and transportation are lacking.
However, fourth-generation antibody/antigen tests, which narrow the period in which HIV infection cannot be diagnosed down to a window of around three weeks after exposure, could be used in primary health care settings. Further innovation in detecting acute infection could further shrink this window period.
Their findings, the authors believe, suggest the potential for identifying large numbers of Africans with acute or early HIV infection by co-ordinating HIV and malaria control strategies.
The authors aconclude, “With the arrival of reliable diagnostics capable of identifying acute HIV infections at the point-of-care, screening of populations suspected to have malaria could identify significant numbers of acutely HIV-infected persons [in conjunction with the appropriate counselling and continuum of treatment and care]. Institution of such a strategy in areas that are endemic for malaria could represent a major opportunity for global HIV prevention.”
Reference
Bebell, LM et al. Acute HIV-1 infection is highly prevalent in Ugandan adults with suspected malaria. AIDS, advance online publication, June 2010.
African scientists launch trial in seven countries for vaccine that could save thousands of lives.
NAIROBI, Kenya — A vaccine against malaria to save the lives of hundreds of thousands
of children a year could be available as early as 2012, according to African scientists who are testing the new drug.
There are 247 million cases of malaria every year leading to the deaths of 881,000 people, as reported in GlobalPost's "Bug Wars" series. A total of 3.3 billion people are at risk of malaria in 109 countries. But the worst impact is in Africa and on children: 90 percent of the malaria deaths are in Africa and 85 percent of all the deaths are children under 5 years old.
“We believe that a vaccine for malaria could help save countless lives and redefine the future of African children,” said Dr. Patricia Njuguma, one of the vaccine’s principal investigators, based in Kilifi, Kenya. “Working as a pediatrician I see everyday the effect of malaria on children. I see … the concern mothers have when their children have high fever, convulsions or lapse into coma.”
An international team of scientists announced late in 2009 that the world’s largest trial of a vaccine called RTS,S — or Mosquirix — is underway in seven African countries in order to determine the effectiveness and safety of the drug on a large scale.
The trial is to involve 16,000 children in Kenya, Tanzania, Malawi, Mozambique, Gabon, Ghana and Burkina Faso, all within the malarial belt that stretches across sub-Saharan Africa.
“The first child was vaccinated in Bagamoyo … and to date we have over 5,000 children already vaccinated,” said Dr. Salim Abdulla, the other lead investigator, who works in the seaside town of Bagamoyo in Tanzania.
RTS,S is the most likely candidate to be rolled out as a malaria vaccine in the coming years. According to one of its inventors, Dr. Joe Cohen, a research scientist at GlaxoSmithKline Biologicals in Belgium, the vaccine might be available as early as 2012.
“This is the culmination of more than 20 years of work,” said Dr. Cohen. “Never before has a vaccine been developed against a human parasite, let alone a devilishly complex parasite such as the one responsible for malaria.”
This next stage of testing is expected to last between three and five years at which point there should to be enough information for national regulatory authorities to decide whether to license the vaccine in their countries.
Ultimately the decision will be theirs but Dr. Christian Loucq, director of the non-profit PATH Malaria Vacine Initiative, largely funded by the Bill and Melinda Gates Foundation, was optimistic and insisted that countries should prepare themselves now to ensure rapid distribution of the vaccine when it is ready.
“The vaccine will have to prove … its efficacy and safety, but … we need to get ready today for the vaccine to be available for the children. Today [African governments and international organizations] have to start being prepared and committed.
“We need to start thinking of uptake. So many times a vaccine has been made available and has been [left] on the shelf for a couple of years. We want the vaccine to be used the day it is made available,” said De Loucq.
Besides getting the all-clear from governments another major barrier will be cost, given that the vast majority of those suffering and dying from malaria are the poorest people in the world’s poorest countries.
However, GSK chief executive Andrew Witty said recently, “We’re not going to let price get in the way of access for malaria vaccines. We will be extremely responsible about the way we price this vaccine.”
Though thin on detail the promise was reiterated by the scientific research team.
The vaccine would be an important weapon in the fight against deadly malaria but would be just one part of an arsenal that includes insecticide-treated bed nets, indoor spraying, effective treatment once malaria takes hold and preventative anti-malarials for pregnant women. Even pop music is being used to spread education about preventing malaria.
In earlier phases of the clinical trials of RTS,S that have been ongoing since 1992 it has been shown to reduce malaria by 53 percent in children aged between 5 and 17 months and to reduce by half severe life-threatening malaria in children under 5 years old.
“For the sake of African children … we must move ahead with this vaccine,” said Dr. Cohen.
Malaria accounts for the death of two million children annually
Sokoto — Malaria kills more than HIV/AIDS in Nigeria, Head of Pediatrics, Usmanu Dan Fodiyo University Teaching Sokoto Dr. Muhammad Jiya has said.He spoke yesterday at an interactive forum for doctors and other health personnel in the North -West zone in Sokoto.
Dr. Jiya noted that malaria accounts for the death of two million children annually, stressing the need to prevent the disease.Sokoto State Programme Officer, Malaria control programme, Dr Aminu Shehu, said 30 percent of illnesses handled were malaria related.
He expressed concern that many drugs on malaria purchased from medicine vendors were sub-standard. State Coordinator, Planned Parenthood Federation of Nigeria, Malam Bello Junaidu, urged health personnel to sensitize people on the importance of keeping their environment clean to reduce spread of the disease. He urged people to visit hospitals to address the problem.
WASHINGTON (AFP) – A malaria vaccine tested by US and African researchers in Mali produced a robust immune response in young children, the group most vulnerable to the mosquito-borne disease, a report released Thursday showed.
The vaccine, based on a single strain of the falciparum malaria parasite -- the most common and deadliest form of the parasite found in Africa -- was tested on 100 children between the ages of one and six in a rural part of the west African country of Mali.
The children were given one of three, progressively stronger doses of the vaccine or a control vaccine against rabies.
All three doses of the malaria vaccine were well tolerated by the children and produced "very strong antibody responses that were sustained for at least a year," said the report which was published online Thursday in PLoS ONE, the journal of the Public Library of Science.
In fact, the report said, the antibody levels the vaccine produced in the children were as high or higher than antibody levels found in adults, who have developed immune responses to the parasite over lifelong exposure to malaria.
"These findings imply that we may have achieved our goal of using a vaccine to reproduce the natural protective immunity that normally takes years of intense exposure to malaria to develop," said Christopher Plowe, professor and chief of the malaria section at the Center for Vaccine Development at the University of Maryland's school of medicine, and a lead author of the study.
"I hope this study leads to a lifesaving vaccine for the children of Africa," said E. Albert Reece, dean of the school of medicine.
Although deaths from malaria have been halted in places like North America and Europe, the mosquito-borne disease still claims the lives of nearly one million people a year, mostly in Africa and most of them children under the age of five.
The vaccine tested in Mali targets malaria when the parasite transmitted to the human by a mosquito multiplies in the blood, leading to disease and, if left untreated, often painful death.
Other blood-stage vaccines have been tested but none has shown the ability to prevent malaria, the report in PLoS ONE says.
University of Maryland researchers collaborated with a group of Malian researchers from the Malaria Research and Training Center, led by Mahamadou Thera and Ogobara Doumbo for the study.
Based on the success of the vaccine on the small sample of children, the researchers are conducting a broader trial on 400 Malian children.
That study will also examine whether the single-strain vaccine can protect against the broad array of malaria parasites that exist.
World Vision developed a document highlighting the relationship between the two conditions:
Contents:
BackgroundMalaria and HIV/AIDS* Both diseases intersect at a number of different levels* What you need to know about malaria* Malaria is preventable* Malaria is treatable* Recommendations for addressing malaria and HIV/AIDS.
You can download this document (2p; 1.47MB) here.